Why Caregivers Are Key to Effective Elder Care Planning

In this insightful episode of Advice From Your Advocates Podcast, host Bob Mannor, nationally recognized elder law attorney and dementia advocate, speaks with Josh Klein, founder and CEO of Emerest, Royal Care, and U@Perks, leaders in home healthcare and elder care strategies. This episode explores the critical role of caregivers in effective care planning and elder care, highlighting how their continuous interaction with patients brings valuable insights often missed by traditional healthcare providers. 

Listeners will discover why caregivers are fundamental to delivering personalized, patient-centered care and how their observations improve healthcare evaluations and outcomes. Josh and Bob discuss the limitations of physician-only assessments and the transformative power of caregiver collaboration in elder care. Whether you're a family member, healthcare professional, or advocate involved in caregiving, this episode offers essential perspectives on integrating caregiver knowledge into care planning.

Listen to understand why caregivers are the backbone of elder care and how their contributions are vital for long-term care success.

Brought to you by Mannor Law Group, Excellence in Estate Planning & Elder Care

Host: Elder Law Attorney Bob Mannor

Executive Producer: Savannah Meksto, CDP

Assistant Producers: Samantha Noah, Shalene Gaul

Chapters

• 0:00 Setting The Stage: What Home Care Means
• 2:05 Home Health Versus Personal Care
• 5:20 Building A Care Model That Lasts
• 7:45 U At Perks: Caring For Caregivers
• 12:20 Empathy Over Automation
• 15:30 Keeping Big-Hearted Care Small And Local
• 19:10 Origins, Values, And Community Roots
• 23:00 Dementia Reality And Family Strain
• 26:10 Inside CMS’s GUIDE Program

Transcript

SPEAKER_02: 0:00

You're listening to Advice from Your Advocates, a show where we provide elder law advice to professionals who work with the elderly and their families.

SPEAKER_01: 0:09

Welcome back to Advice from Your Advocates. I'm Bob Manner. I'm a board certified elder law attorney in Michigan. I'm excited about today's guests. We have Josh Klein, who is the CEO behind Emirist and U at Perks. And so, Josh, uh tell us a little bit about yourself and about your companies.

SPEAKER_00: 0:29

Bob, thanks for having me. Appreciate it very much. I'm the CEO for Emirist Health, as well as Royal Care here in the state of New York, where we provide services for the elderly that are homebound. We do home health, which is the more clinical interventions that people need post-acute, post-hospitalization and nursing homes to keep them at home with nurses, physical therapists, occupational therapy, and as well as personal care. And we're we do so in more than six states and employ thousands of caregivers and hundreds of nurses and physical therapists and dozens of doctors.

SPEAKER_01: 1:05

That's great. So I have this ongoing argument with my social workers that work at my law office, and they talk about home care, and they talk about it in a similar way of you, which is more of the clinical home care that is the nurses and the physical therapists and the occupational therapists and all of that. But what I hear from you, what I'm hearing is you do both sides of that. You do the more clinical part of it, which is often called home care but is only a few hours a week. You also do the personal services care, which is what I like to call home care because it's more of a which I think families understand when they when families hear home care, sometimes they're imagining somebody that's gonna help them get dressed and get showered and you know make it through the day, make it to the bathroom, all those types of things. So, but you I think do both sides of that. You do the personal care part of it and the clinical care.

SPEAKER_00: 1:58

Yes. And I'm glad you bring up that confusion. You are a hundred percent correct. It took me, which I'm in the industry, I'm blessed to be in this 20 plus years. The industry, when you're talking business to business, right, healthcare space, they'll understand there is health, and that's that is the nursing side of it. That's the federal program that the federal government gives you, grants you a licensure to deliver that level of care, which is the nurses that they go in and make an assessment. There's a nurse that makes sure that your medication is done properly and they organize that clinical aspect of the care. And then if somebody's after hip surgery, a physical therapist, that's more on the more clinical care, which is in the industry called home health. And then there is personal care services, which in the majority of the states is called a licensed agency, not a home health agency. So you I'm glad that you're bringing that up. So, people, there is a difference in that. I started off with the license, which is the more is the personal care, the people that actually make sure the bathing, changing the people at home, their laundry, personal care. That's where I started. That's my introductory where my parents gave me my first opportunity to do, and we went into more of the clinical thing. So there is a difference, and we do both. And the longer we're doing both, the better we're getting at making care that the patient has an opportunity to stay at home longer, healthier, and much much better results. And we can talk about those results and what we do differently in order to obtain those results.

SPEAKER_01: 3:25

Very nice. Now, you also, and this is really uh something I think is very nice. You also have U at Perks, which is actually for the caregivers. It's to benefit the caregivers. So tell us a little bit about that.

SPEAKER_00: 3:38

Yeah. So one of the things that uh we've realized a long time ago, I've realized this will give you by way of background. I always volunteer as an EMT. And then I transitioned about approximately five years ago, six years ago, I was ready certified. Like the EMT status wasn't good enough for me. My ADD wouldn't allow me just to stay as an EMT, and I went to school to become a paramedic. One of the things that I've learned in being out in the field a lot is just because you sometimes will go, I'll give you a perfect example, you go to a doctor's office or a pediatric office, and if there's an emergency called where something in emergency happens in a doctor's office with it with a child, and you're walking to an office and you're saying, just a second, there's a physician there that went 14 years to school for a specialty, and he calls the volunteer ambulance organization that we call, and the doctor is sitting there and he can't even, he can't help it. He's like, he has no, and I'm like, I just went to school for two years. How am I the one that he's referring to? He went 14 years to school. And and and that's a real glaring, you know, example of even though he's a physician, but when it comes to an emergency, that's not his right, that's not his specialty. When an emergency comes, he's not trained to deal with something acutely that's happening now. Right. A personal care assistant, just because they don't have a licensure as a physician, does not mean that what they bring to the table when they're in the home, when they actually do the bathing, when they actually do the personal care for the patient's needs, that they don't have a specialty. They don't have, they don't add equal value as a physician. So to us, when somebody's in a home for 20 plus hours a week, they have a lot more insight than any physician sometimes or any nurse that comes in for 45 minutes to make an assessment because they know the patient longer. Right. And the when we realize that aspect of it is a home health aid, if you're gonna build them, if you're gonna want to get those type of little things that they can bring, it's not little, they can bring, how do we, how do we gain their trust? How do we train them in the limited capacity that they're trained? Right. And the one thing that we've learned is we you can teach people a lot of things. You can teach people law, you can teach people clinical things. One thing that you can't teach them is to care. You can't teach somebody to actually care. So what we did was how do we how do we get how do we get better? Because to get a home health aid to say that their legs are swelling, it's not that it's not a town, it's just caring. Oh, I care enough to report it. Yeah. So we said, how can we bring that in masses? Is the only way was if we're not going to showcase to them that we care about them, it's never gonna work. If we're not gonna pay them better than anyone else, and if we're not gonna come up with a concept that really, you know, lead by example, what are you doing to care? So what we built was, I'll give you the the example, is a Delta Lounge that you see in the airports, you know, these airports. So what we built is these cafes, spaces for home health aides to come where they get there's a nice cafeteria. Nice. The majority of our workforce are women. So what we did was it's 97%, and we built hair salons where they get their hair done for free, they get manicures, pedicures, facials, and this is all free of charge. And that is something that all our caregivers get free access to. It's based upon their performances. Everybody gets a baseline for working here, but if you want to have on certain occasions, you want to have, you want to get dolled up. And us men, when we get a nice good haircut, we feel good about ourselves. Right. Women's all I mean. So that is something that we've had enormous success. Is that concept is first, if you want them to care for others, first show that you care for them. So that's that perks program, and that's what the idea is behind it.

SPEAKER_01: 7:27

So let's talk a little bit more about that. So that is, I 100% agree with you. It's so important. And when I see this in the long-term care industry, it makes such a big difference about, you know, I call it empathy, you call it care caring for the patients, but it is very difficult. It is something that seems to be more of an innate attribute rather than something that we can completely train for, but we can certainly grow it if it's there. Like you said, you know, we can certainly encourage caring and empathy. And so I I I love that concept. Talk a little bit more about yeah.

SPEAKER_00: 8:05

Empathy is is something again, and that talking about the the way you're mentioning it, that you all these technology companies now that are emerging and everybody, you know, the buzzword AI, uh, yeah, artificial intelligence. And I've been pitched more than a catcher now in postseason on all these types of products. I've been I'm dizzy from pitching already, uh, from listening to so many pitches and all the power to them for trying. And there's a lot of things and artificial intelligence, it's artificial. And the reason it's artificial, it doesn't have empathy, to your point. Yeah, the machine can't uh produce empathy, it just doesn't, it can give you insights in into certain things, but it won't, you know, it won't be empathetic. So the first to answer your question is to understand who is the people that aren't walking into your door to begin with. These are majority of the people that did not say, do I want to become a marine biologist or a home health aid? That's not how it went. These are caring people. So at least knowing your audience is number one, knowing the people that want to do this job. And we one of the things that we do with this data is picking up who are these people? Where did they work for beforehand? Is there a pattern that these people are coming from a caring type of job type of thing? It's not a matter of they're coming from a fast food chain. Is it something that people are, what's my last resort? But the majority of these surprised are people that are either they had a family member that wasn't well, and they're like, that's something, that's my calling. And it's building upon that so you can actually get the best of them because these are caring people that actually want to do this job. I make it my business all the time, is a never go away from the core of it, as much as sitting in no pun attendant in a white white chair in an office, is hang out with the caregivers just to listen. Listen, listen to what we're saying. These are caring people to begin with, and and and you could build on that, knowing that your baseline is empathetic, good, kind people that went into this line to begin with.

SPEAKER_01: 10:02

It's funny you talk about AI. I was chuckling a little bit while you were saying that, because you know, I've been playing around a lot with AI, and I have different apps that use the AI artificial intelligence for those that aren't aren't up to date on that. But one of them in particular is it starts to learn, right? You know, it's learns me and it learns some of the things that I talk about. After a few months of learning the things that I am requesting of it, it is probably the most complimentary thing that I like it's more it's nicer to me than anybody else. So it's it's kind of funny because the AI does it picks up on the things that you do and say, Oh, you're doing a great job. Congratulations for being part of helping elders and things like that. Like, no one else tells me that kind of stuff. So it's kind of it it is interesting what the wave of the future might be, is that AI is gonna be part of this, even though you say you're right, it doesn't really have empathy, it really doesn't have that. But I do believe that there's gonna be an element of this that is provided by AI.

SPEAKER_00: 11:07

Well, no question. There's I think there's so many advantages that we have no idea what's coming. So to your point, what are the tools that are coming out of this that could be attributed? Is there something that we can give for our caregivers? Exactly what you're saying. If we gave our caregivers the on the power app that they use and we give them that bot that they can ask, you know what? I see my patient is in a bad bad mood today due to that. What can I do to cheer them up? Yeah. That's that's a perfect example. Maybe you tell them here are three jokes that you can actually there is multiple ways how that it's going to hell. Yeah, there's no question. Or actually, oh, I'm seeing this on my patient. We want to make sure that they're not becoming physicians or social workers or mental health counselors if they aren't. But in their capacity, there's undoubtedly bunk to bring. But to actually be the one that's talking in, you still need that human. Yeah.

SPEAKER_01: 12:03

Tell me more about how, because you mentioned this earlier and I want to explore it a little further. How you feel like your home care agency or your home care options are different or that, you know, have what's special about your home care options?

SPEAKER_00: 12:19

So they are very kind, good operators in multiple states. We're not the only ones, but there are some incredible operators. And I generally mean that. And I'm I think one of the things that we're very good at is learning what others others do good. And we're constantly learning and not saying ourselves, we have even even this perks program. We're the only ones that are doing it, which is very, very, very nice. But this still doesn't mean just because that's our idea, that's the only idea, and that's why we should go on to your show and let everybody know that this is what we're doing. There are some bright, caring people that are on this industry, and we never stop listening and learning what are others doing well that are better than us? How can we be a better age? So, first and foremost, we're learning equity. As as big as we're fortunate to get, is how do we stay mama pop? You know, if and I keep on putting myself, if when, not if, when I'm going to need services or I'm gonna need it to my own parents, right? If is my is my knee-jerk reaction, not just because it's my company or it's the people that I'm close with that run it, is that the company that I'm going to call that's going to listen to me, that's going to pick up my phone, that's going to have somebody that's really going to be engaged with me properly throughout from when you start the care till the finish line to whenever that cycle, the life cycle of the home health care and the personal care is, is that are we the right company for that? And that is something that we're, and we're we do some really different stuff. That means, for example, every service line, if it's the nursing and the home health side, it's a separate entity on its own, not just from a legal perspective and DBA, et cetera, but from management to everybody that's involved in that arena runs their own and perfecting everything within their thing. And that goes state by state. So we're not a franchisee entity, we're a real entity, but we operate with that mindset. What are you doing for your population, the people that you're blessed to serve, the things that you need to execute? As the real work that went in is don't become an enterprise. Yes, from a business standpoint, of course, it's very, very good that the outside people in the business world sees us that way. But the moment we go away from that mindset and start saying, Well, how can we make this scale all those fancy words? We're not in healthcare. Scale is very good when you're selling a commodity. When you call service and caring, and if you walk away from that, you're only as good as your product is, and now a product is caring as services. So we're super, super not just careful, but we actually do certain interventions that make sure that that's the case.

SPEAKER_01: 14:51

Yeah, that's great. So tell me, Josh, a little bit more about your background, how you got into this. Well, you're clearly passionate about this, and so what gave you that passion? How did you get into this? And how did this become, you know, mission?

SPEAKER_00: 15:05

Yeah. Blessed to have great parents as much as I'd want to give myself credit that uh but I I was raised well.

SPEAKER_01: 15:13

Yeah.

SPEAKER_00: 15:13

Raised an Orthodox Jewish kid from Brooklyn. Yeah. Didn't make it past high school. And but I my parents, um, my mom had a nurses' agency where she supplied nurses for nursing homes and hospitals. She was an agency. And I grew up in a nimble, real, tight-knit community where it was predominantly Orthodox Jews. And my mom had nurses from different backgrounds, African Americans, Asian, you name it, that used to come with the buses to our home in a neighborhood that they stuck out like a sore thumb. And my mom was as proud as a peacock that these people are coming to her home. She used to love it. She used to love that this aspect of it coming into this community and showcasing that she actually employs people from different backgrounds. My dinner table used to be all different walks of background. Yeah. Hanukkah time, which usually comes out on Christmas, there were a bunch of reindeer and Christmas wrappings in our dining room. So I saw a real genuine that it makes no difference, not just besides a human as a human, but truly understanding somebody that's a nurse or a caregiver, somebody that cares, is to hold on an extremely high pedestal. And my that's that that I had to my mom. My my my my dad ran a nursing home in Washington Heights here in in New York. And I watched him be an administrator overlooking patients. And as a young kid, the days off, one of the fun things that we had is going to his nursing home on the day off. I don't recall the time that patients wouldn't, oh, you're Mr. Klein's son. Oh, your father's so sweet, no, he's scared. So uh the the the the real the real background is is seeing my parents do the right thing. Yeah. In in in in in a very profound openness to other cultures, other people teaching me that race is just a color and it's the person is still special and equal. And I give that they started me in this, and I was able to not mess it up more than anything else. That's great.

SPEAKER_01: 17:09

I I know this is gonna sound like it's a little off topic, but it's one of my favorite responses to this type of a question. Remember the the guy that I think it was what the Academy Awards or whatever, where and I can't think of the guy's name, but Will Smith smacked him. Uh what's his name? Chris Rock, yeah. Thanks. So Savannah's in the background. Chris Rock, and Chris Rock's response to because people would ask him, you know, he's he smacked you, right? On stage. Why didn't you respond? Why didn't you like hit him back or something? And his response was because I have parents. And I was like, that's the best response you can get to that. Yeah. Yes, yes. No, I so I appreciate all the work that you do. Uh I I really think it's really interesting. Can you talk to us a little bit? We uh years a few years back, we started realizing that a good portion of the people that we help, and I'm guessing a good portion of the people that you help have some memory loss or dementia. And can you talk about how that affects caregiving? I know how it affects the work that we do to make sure that we advocate for care because the person sometimes isn't able to advocate for themselves as well as they might have been previously. So I know how that affects the work that I do. Tell me a little bit more about how that affects the work that your your companies do.

SPEAKER_00: 18:31

So this might have not even been now a pre-conversation, and I'm super glad you bring that up because the federal government saw an enormous need of people with dementia and memory care loss. People, I'll give you per personal level what I know, and then I'll tell you where we stand with this program today. So the federal government has put rolled out a program which is called Guide, a Guide Program. Yes, this is a great program, yes. And Emirist has been approved as a guide provider. That's great. I'm glad that you're bringing that up. And the previous call prior to this podcast was with this team, with the care navigators of this team. And sometimes we get very, very lost when it's a business and like, oh, what's the business model? And I keep on telling my team, no, no, no, no, no, no, no. Stop. I'm not interested in how we get leads people that want, what's our product? What are we doing different for helping caregivers that are dealing with families that are dealing with somebody with dementia? That needs perfection, enormous amount of patience, enormous amount of listening, understanding what are the issues, anxieties, problems, things, how can we help them genuinely help them? Stop looking at economics as b as much as it's a business model. The economics will follow if you actually deliver something good. It will come. And one of the things I'm passionate about it, because you know, I I think I'm I'll mention it again. I I average 500 emergency calls a year as a paramedic. The majority, uh nine. 90% are in the middle of the night. My wife is dull enough to let me do this. I sleep in scrubs. And I see firsthand the anxiety and the issues that family members have with people with dementia. If I tell you how brutal it is to take care of somebody that has dementia, where they look healthy, they physically look healthy, but they're sadly if they're advanced and the family is just so, so, so lost. I'll give you a simple example. If if their loved one needs a haircut sometimes, do you know that it takes three people to hold them down to take a giveaway? And people don't understand how many. I mean, I'll just give you a tiny little example. I'm not even talking about wandering, leaving the house, locking the doors. How many people I've seen, and I from the community that I went to the school, I'm like, oh, where's the husband? Oh no, they had to get a new apartment. They had to get a new apartment because it wasn't livable anymore. Right. They couldn't execute. So, first and foremost, is understanding is how bad is are these problems for the family? Then you can fix them and understand what are the things that they need help for. Is it respite? Is like, do they need a break? Does the family caregiver that's taking care of get somebody that understands that don't just send in a caregiver that actually not caregivers are all amazing, but are they trained to deal with that patient that has dementia? Do they understand that they're dealing with an illness that's not something that the patient is doing? So it's a lot of care navigation. It's understanding, listening, giving support. We have support groups now that we have caregivers that care for people with dementia, talk to each other, get good ideas off of each other. So we're we're putting an enormous amount of effort and into this. I'm glad that you're bringing it up because we are a guide provider in this. To tell you that I have a lot of answers is wrong. I don't, because we're fairly new in it. But I would bet that in a year from now, if we have to have an opportunity to speak about this again, I'll have a lot more insights. But to the limited capacity, is we're at the we're literally at the floor trying to get better products to be able to deliver a better product for dementia patients.

SPEAKER_01: 22:06

Talk about the guide program because that's actually something and I I agree with you. It's a great program. We've started to explore it here in Michigan, and we're we're looking into different things that we can participate with, but I think a lot of our listeners might not be familiar with the guide program. So can you just kind of give us an idea of what that program is?

SPEAKER_00: 22:26

Yes. So the government really wanted, sadly, it usually boils down to the reason these things are transformative is money. Money. Always. When in doubt, it's money. Yeah, always. And the federal government saw an enormous burden of hospitalizations that occurred with dementia patients. And the reason wasn't because clinically something was wrong with them. It wasn't because they were having a heart attack. It wasn't because they their vital signs were so out of whack. It was because the family member just simply couldn't deal with it. It's they're like, you know what? They had they sometimes even looked for an excuse. Oh, look, something, no, it's not the dementia. My mom, my my mom or dad are sluggish. So just simply they just needed a break. They needed a break. So the government says, how can we stem that influx into the hospitals? And and the the program is to be a there is approximately 80 hours a year that we can give respite care for caregivers. That's great. And that's it's not, it's good enough. I mean, it's it would it's better if there's more, but that's a great start. It's it's correct, it's a great start. So that's a big, big, big chunk. How much can you give a break for the caregiver? Care navigation is also means where they have somebody, they have a direct person that's the care navigator. If the if the family says, you know what, uh food insecurity, transportation, a lot of these things that they just didn't have support, dedicated for somebody that understands that population, is to navigate them, food, heat, all those things that the family member is dealing enough with the patient themselves, we do all the outside stuff for them. So at least it takes away the burden. It's a matter of guiding patients for people that have dementia, helping them, giving them the right tools. Do they have the proper grab bars in the home? Are they have the real right support in that home to be able to keep them at home and out of the hospital for no apparent reason? But I think one of them, at least for now that we're learning, the biggest utilizer currently is this respite care. That's the number one what we're seeing. I think we're gonna learn more from our data. And I'll, you know, but for the for to answer you right now, the biggest piece is the respite care for the key for interesting.

SPEAKER_01: 24:42

Well, we've been talking to Josh Klein. I I think uh one of the best ways to get a hold of him is at his website, which is emerist.com. I'm gonna spell that out just to make sure you get that em-er-e-st.com. Is there other ways to get a hold of you, Josh?

SPEAKER_00: 24:59

Uh if you call uh uh an emergency number in my neighborhood, the chances are the one that'll show up. I think that's that's a uh you know, I don't think my cell phone number would be a good idea for your audience.

SPEAKER_01: 25:10

No, probably not. So, Josh, any takeaways that you want to give our audience before we wrap up?

SPEAKER_00: 25:17

I'm I I I'm blessed to do these podcasts. I can it takes two to have a conversation. Yeah. First and foremost, I read up about your firm. Just the mere fact that you're speaking about these things says a lot about your firm and what you're doing. That's my takeaway. You caring about this population. I think you know, sometimes lawyers get a bad rap and elder care to do so. And, you know, I always I feel that I'm blessed that we do this. You know, that our business is caring for others. And I read up about yourself. Uh, you should be proud that this is what you do, that your law firm really does elder care. I'm sure in your capacity, you walk away a day of helping somebody navigate their finances within this elder care space. You know, it's very easy for me to come here and pompous my business. And I think that's just I like to walk away what I learned from you, and not just what you learned from me, is what your firm is doing in the state of Michigan and for the other people that you're helping. Kudos to you, what you're doing, and God bless you for being in this line, picking this line, and most importantly, amplifying this message to others. What we do is home health care and caring the right way, understanding that there's a reason how we met, giving me the opportunity to speak about in general terms of home health, the guide dementia program. You didn't even know that we had a guide program, but when you care, this is what comes out when you do care. So, all the power to you and your team of what you do in your space. And collectively, there's a lot of good that comes out from these conversations. People get ideas. You know, they had a good idea. This attorney spoke to that. How can we make a better place for people that are struggling in their health? So, my takeaway is thank you for making this happen. And I I truly appreciate it.

SPEAKER_01: 27:03

Well, thanks, Justin, for everyone. Don't forget, if you enjoyed this program, we you can subscribe anywhere that you listen to podcasts. And we'll see you next time. Thank you.

SPEAKER_02: 27:23

Thanks for listening. To learn more, visit Manor Law Group.com.